The bone ring technique is a surgical methodology that allows bone augmentation and implantation in a one-stage procedure. Compared to the more conventional two-stage approach, the main advantage of the bone ring technique is that of significantly reducing the treatment time by several months. The bone ring technique enables vertical/horizontal augmentation and formation of new bone, thereby simplifying the surgical treatment of 3-dimensional bone defects. The technique is applicable for almost all indications, including sinus lift with a limited maxillary bone height.
According to the original approach, the augmentation is performed with autologous bone rings, which are harvested intraorally (mostly from the chin area or palate) with a trephine. The bone ring is then transferred to the trephine drill-prepared recipient site. The implant bed is thus prepared in the local bone through the ring opening, and the implant is inserted through the ring. The bony integration of the bone ring and implant occurs via the surrounding bone.

Carefully consider the soft tissue situation prior to surgical intervention! Please keep in mind that a tension-free closure of the flap is essential for the success of the procedure.

Rehydration

maxgraft® bonerings do not need to be rehydrated. Preparation of the ring bed using the maxgraft® bonering surgical kit ensures close contact of the bone ring to vital bleeding bone, enabling fast integration of both, implant and bone graft.

Re-entry

Once maxgraft® bonering is fixed with a suitable implant, it provides great primary stability. Implant loading should be performed 6 months after transplantation to avoid resorption of the bone graft caused by a lack of mechanical stimulus.

Combination with cerabone®

The combination of maxgraft ® bonering with a xenogenic material (cerabone®) combines the advantages of both materials; the biological potential of maxgraft® bonering induces fast incorporation of graft and implant, the volume-stable cerabone® acts as a barrier against resorption and improves the esthetic outcome.

Graft exposure

Wound dehiscence and graft exposure can be common complications of augmentation. After removal of necrotic soft tissue and infected hard tissue (use rotating instruments if necessary) the augmented area should be rinsed with chlorhexidine. Subsequently, the graft has to be covered again, if necessary, by harvesting a palatal soft tissue transplant.

Augmentation durch Einsetzen eines maxgraft® bonering

botiss offers prefabricated allogenic bone rings, whose use minimizes the risks associated with the harvesting procedure and reduces the post-operative pain as well as the risk of infection and operation time. maxgraft® bonering is a sterile, highly safe allograft product derived from the femoral heads of living human donors. The prefabricated rings can be placed press-fit into the prepared ring bed.

In addition, botiss offers a surgical kit that provides all necessary instruments for the bone ring technique. The first step of the surgical procedure is the determination of the position of the implant using the pilot drill; the ring bed is then prepared with a trephine. Subsequently, the use of a planator enables an even paving of the local bone to achieve an optimal contact with maxgraft® bonering as well as the removal of the cortical layer, which improves the graft revascularization. With maxgraft® bonering, a vertical bone augmentation of 2–3 mm above bone level can be easily performed. For the augmentation of a severely atrophic mandibular, a width of the ridge (in the case of a parallel-walled ridge) of at least 4 mm is necessary for a successful application of maxgraft® bonering. The technique is also applicable for a one-stage sinus lift with minimal maxillary bone height. In this case, the implant is fixed in the sinus with the allogenic bone ring; these are held together with a membrane screw.

It is recommended to fill the residual defect volume with a slowly resorbable bone regeneration material (i.e., cerabone®) and to cover the augmentation site with a collagen membrane. The pericardial Jason® membrane is an ideal solution in such a situation due to its long-term barrier function. A tension-free suturing of the operation site minimizes the risk of tissue perforation and/or graft exposure.